J Korean Orthop Assoc.  2009 Aug;44(4):455-460.

Intramedullary Decompression for the Treatment of Unicameral Bone Cysts in Children

• Yun YH
• Shin SJ
• Seo JH

Abstract

PURPOSE
The present study aims at evaluating our results of intramedullary decompression of the unicameral bone cysts in children with using flexible nail(s) or titanium cannulated screws. MATERIALS AND METHODS: We treated fourteen children with unicameral bone cysts by intramedullary decompression. Eleven cases were in the metaphysis of long bones (seven in the proximal humerus amd four were in the proximal femur), which were all treated by flexible intramedullary nailing; while a cancellous screw was axially placed in three cysts of the short bones (all in the calcaneus). The mean age of the patients at the time of surgery was 11.8 years, and the mean duration of follow-up was 16.7 months. The final outcome was radiographically classified into the four categories of Capanna et al.,; completely healed, healed with residual radiolucency, recurred or having no response. RESULTS: All of the cysts In the long bones responded to treatment. Seven cysts healed completely, and three healed with residual radiolucent areas visible on radiographs. One cyst, which initially appeared completely healed, recurred after the removal of nails. The healing period varied from three to 36 months. For the calcaneal cysts, there was no definite sign of effective consolidation in all three cases. CONCLUSION: Intramedullary decompression by flexible nailing for the treatment of unicameral bone cyst of a long bone was effective in providing early stability and for accelerating consolidation of the cyst. Its surgical intervention is minimal, and the result is predictable. Our trial of placing a screw in the calcaneal cysts was unsuccessful according to the short term follow-up.

Keyword

Unicameral bone cyst; Intramedullary decompression

MeSH Terms

Bone Cysts
Child
Decompression
Follow-Up Studies
Humans
Humerus
Nails
Titanium
Titanium

Figure

• 

  Fig. 1 (A) A typical unicameral bone cyst with pathological fracture in the proximal humerus of a 15 year old boy. Fracture healed at 3 months. But it refractured at 4 months. (B) At 8 months, we tried the steroid injection, which was not effective until 12 months. (C) So we inserted a Titaium Elastic Nail for the continuous intramedullary decompression. (D) It healed at 21 months after nailing.

• 

  Fig. 2 (A) A unicameral bone cyst in proximal femur of a 6 year old girl, which was incidentally found without fracture. (B) After fixation with two Titanium Elastic Nails, it appeared to be completely healed at only 3 months. (C) The nails were removed at 6 months. (D) But at 16 months it partially recurred at the same location. Final result of this case was classified as the 'recurrence after healing'.

• 

  Fig. 3 (A) A calcaneal cyst in a 15 year old boy. A steroid injection was not successful until 6 months. (B) A cancellous screw was placed through the cyst in axial fashion. We anticipated the decompression of cyst with subsequent healing, which was not occurred until 12 months.

Reference

1. Oppenheim WL, Galleno H. Operative treatment versus steroid injection in the management of unicameral bone cyst. J Pediatr Orthop. 1984. 4:1–7.

2. Catier P, Bracq H, Canciani JP, Allouis M, Babut JM. The treatment of upper femoral unicameral bone cysts in children by Ender's nailing technique. Rev Chir Orthop. Reparatrice Appar Mot. 1981. 67:147–149.

3. Capanna R, Dal Monte A, Gitelis S, Campanacci M. The natural history of unicameral bone cyst after steroid injection. Clin Orthop. Relat Res. 1982. 166:204–211.

4. Bovill DF, Skinner HB. Unicameral bone cysts. A comparison of treatment options. Orthop Rev. 1989. 18:420–427.

5. Farber JM, Stanton RP. Treatment options in unicameral bone cysts. Orthopaedics. 1990. 13:25–32.

6. Scaglietti O, Marchetti PG, Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. J Bone Joint Surg Br. 1979. 61:200–204.

7. Scaglietti O, Marchetti PG, Bartolozze P. Final results obtained in the treatment of bone cysts with methylprednisone acetate (depo-medrol) and a discussion of results achieved in other bone lesions. Clin Orthop Relat Res. 1982. 165:33–42.

8. Campos OP. Treatment of bone cysts by intracavity injection of methylprednisone acetate: a message to orthopedic surgeons. Clin Orthop Relat Res. 1982. 165:43–48.

9. Brougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of deminiralized bone matrix and autogenous bone marrow. J Bone Joint Surg Am. 2002. 84:921–929.

10. Yandow SM, Lundeen GA, Scott SM, Coffin C. Autogenous bone marrow injection as a treatment for simple bone cyst. J Pediatr Orthop. 1998. 18:616–620.

11. Wright JG, Yandow S, Donaldson S, Marley L. Simple Bone Cyst Trial Group. A randomized clinical trial comparing intralesional bone marrow and steroid injections for simple bone cysts. J Bone Joint Surg Am. 2008. 90:722–730.

12. Shinozaki T, Arita S, Watanabe H, Chigira M. Simple bone cysts treated by multiple drill-holes. 23 cysts followed 2-10 years. Acta Orthop Scand. 1996. 67:288–290.

13. de Sanctis N, Andreacchio A. Elastic stable intramedullary nailing is the best treatment of unicameral bone cysts of the long bones in children?: Prospective long-term follow-up study. J Pediatr Orthop. 2006. 26:520–525.

14. Givon U, Sher-Lurie N, Schindler A, Ganel A. Titanium elastic nail - a useful instrument for the treatment of simple bone cyst. J Pediatr Orthop. 2004. 24:317–318.

15. Roposch A, Saraph V, Linhart WE. Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones. J Bone Joint Surg Am. 2000. 82:1447–1453.

16. Abdel-Wanis ME, Tsuchiya H, Uehara K, Tomita K. Minimal curettage, multiple drilling, and continuous decompression through a cannulated screw for treatment of calcaneal simple bone cysts in children. J Pediatr Orthop. 2002. 22:540–543.

17. Saraph V, Zwick EB, Maizen C, Schneider F, Linhart WE. Treatment of unicameral calcaneal bone cysts in children: review of literature and results using a cannulated screw for continuous decompression of the cyst. J Pediatr Orthop. 2004. 24:568–573.